Abstract
Background
Transgastric debridement of walled off pancreatic necrosis (WOPN) is a surgical treatment option for patients requiring pancreatic debridement for necrotizing pancreatitis. The reported experience with surgical transgastric pancreatic debridement is limited, however, the lower incidence of postoperative pancreatic fistulae with this procedure compared to other options warrants further evaluation of this technique.
Method
Retrospective chart review.
Results
Twenty-two patients underwent transgastric debridement with a cystogastrostomy for clinically symptomatic WOPN from January 1, 2005 to July 31, 2013. Eight cases were performed laparoscopically and 14 were performed by an open approach. The mean patient age was 50.9 (50.9 ± 14.5) and the median American Society of Anesthesiologist score was 3. The most common etiology for pancreatitis was gallstones and the median time from attack of pancreatitis to definitive surgical management was 60 days (range 22–300 days). Median operative time was 182 min (range 85–327 min) with 100 cc (range 20–500 cc) of blood loss. In seven patients the necrosis was infected and in 15 patients the necrosis was sterile as determined by the intraoperative culture of the necrotic material. The overall significant morbidity (Clavien type 3 or greater) was 13.6 % and the mortality was 0 %. The incidence of postoperative pancreatic fistula was 0 %. 20 patients (90 %) were symptom free during a median follow-up of 12 months.
Conclusion
In selected patients with clinically symptomatic WOPN, surgical transgastric pancreatic debridement appears to be a safe procedure with a low morbidity and mortality. The low incidence of postoperative pancreatic fistulae warrants further evaluation.
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References
Connor S, Raraty MG, Howes N, Evans J, Ghaneh P, Sutton R, Neoptolemos JP (2005) Surgery in the treatment of acute pancreatitis—minimal access pancreatic necrosectomy. Scand J Surg 94:135–142
Gluck M, Ross A, Irani S, Lin O, Hauptmann E, Siegal J, Fotoohi M, Crane R, Robinson D, Kozarek RA (2010) Endoscopic and percutaneous drainage of symptomatic walled-off pancreatic necrosis reduces hospital stay and radiographic resources. Clin Gastroenterol Hepatol 8:1083–1088
Stamatakos M, Stefanaki C, Kontzoglou K, Stergiopoulos S, Giannopoulos G, Safioleas M (2010) Walled-off pancreatic necrosis. World J Gastroenterol 16(14):1707–1712
Babu BI, Siriwardena AK (2009) Current status of minimally invasive necrosectomy of post-inflammatory pancreatic necrosis. HPB 11:96–102
Babu BI, Sheen AJ, Lee SH, O’Shea S, Eddleston JM, Siriwardena AK (2010) Open pancreatic necrosectomy in the multidisciplinary management of postinflammatory necrosis. Ann Surg 251(5):783–786
Rodriguez JR, Razo O, Targarona J, Thaver SP, Rattner DW, Warshaw AL, Fernandez-del Castillo C (2008) Debridement and closed packing for sterile or infected necrotizing pancreatitis: insights into indications and outcomes in 167 patients. Ann Surg 247:294–299
Palanivelu C, Senthilkumar K, Madhankumar M, Rajan PS, Shetty AR, Jani K, Rangarajan M, Maheshkumaar GS (2007) Management of pancreatic pseudocyst in the era of laparoscopic surgery—experience from a tertiary center. Surg Endosc 21:2262–2267
Papachristou GI, Takahashi N, Chahal P, Sarr MG, Baron TH (2007) Peroral endoscopic drainage/debridement of walled off pancreatic necrosis. Ann Surg 245:943–951
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13
Frey CF (1993) Management of necrotizing pancreatitis. West J Med 159:675–680
Büchler MW, Gloor B, Müller CA, Friess H, Seiler CA, Uhl W (2000) Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg 232:619–626
Munene G, Dixon E, Sutherland F (2011) Open transgastric debridement and internal drainage of symptomatic non-infected walled-off pancreatic necrosis. HPB 13:234–239
Boland B, Colquhoun S, Menon V, Kim A, Lo S, Nissen NN (2010) Current surgical management of infected pancreatic necrosis. Am Surg 76:1096–1099
Hritz I, Fejes R, Székely A, Székely I, Horváth L, Sárkány A, Altorjay A, Madácsy L (2013) Endoscopic transluminal pancreatic necrosectomy using a self-expanding metal stent and high-flow water-jet system. World J Gastroenterol 19(23):3685–3692
Sandrasegaran K, Tann M, Jennings SG, Maglinte DD, Peter SD, Sherman S, Howard TJ (2007) Disconnection of the pancreatic duct: an important but overlooked complication of severe acute pancreatitis. Radiographics 27:1389–1400
Fernandez-del Castillo C, Rattner DW, Makary MA, Mostafavi A, McGrath D, Warshaw AL (1998) Debridement and closed packing for the treatment of necrotizing pancreatitis. Ann Surg 228:676–684
Van Santvoort HC, Besselink MG, Horvath KD, Sinanan MH, Bollen TL, Van Ramshorst B, Gooszen HG, Dutch Acute Pancreatitis Study Group (2007) Videoscopic assisted retroperitoneal debridement in infected necrotizing pancreatitis. HPB 9:156–159
Parekh D (2006) Laparoscopic assisted pancreatic necrosectomy: a new surgical option for treatment of severe necrotizing pancreatitis. Arch Surg 141:895–903
Horvath K, Freeny P, Escallon J, Heagerty P, Comstock B, Glickerman DJ, Bulger E, Sinanan M, Langdale L, Kolokythas O, Andrews RT (2010) Safety and efficacy of video- assisted retroperitoneal debridement for infected pancreatic collections: a multicenter, prospective, single-arm phase 2 study. Arch Surg 145(9):817–825
Van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, Van Goor H, Schaapherder AF, van Eijck CH, Bollen TL, van Ramshorst B, Nieuwenhuijs VB, Timmer R, Laméris JS, Kruyt PM, Manusama ER, van der Harst E, Van der Schelling GP, Karsten T, Hesselink EJ, van Laarhoven CJ, Rosman C, Bosscha K, de Wit RJ, Houdijk AP, van Leeuwen MS, Buskens E, Gooszen HG, Dutch Pancreatitis Study Group (2010) A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 362:1491–1502
Kulkarni S, Selby R, Boswell W, Matsuoka L, Parekh D (2011) Laparoscopic assisted transabdominal pancreatic debridement: a safe and effective treatment option for necrotizing pancreatitis. Gastroenterology 140:S383
Matsuoka L, Parekh D (2012) The minimally invasive approach to surgical management of pancreatic diseases. Gastroenterol Clin N Am 41:77–101
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Drs. Kulkarni, Boagart, Matsuoka, Buxbaum, Selby and Parekh have no conflicts of interests or financial ties to disclose.
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Kulkarni, S., Bogart, A., Buxbaum, J. et al. Surgical transgastric debridement of walled off pancreatic necrosis: an option for patients with necrotizing pancreatitis. Surg Endosc 29, 575–582 (2015). https://doi.org/10.1007/s00464-014-3700-x
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DOI: https://doi.org/10.1007/s00464-014-3700-x